5124.151
Initial rates for services provided by a new ICF/IID.

(A)
The
total per medicaid day payment rate determined under section 5124.15 of the
Revised Code shall not be the initial rate for ICF/IID services provided by a
new ICF/IID. Instead, the initial total per medicaid day payment rate for
ICF/IID services provided by a new ICF/IID shall be determined in
accordance with this section.

(B)
The initial total medicaid day payment rate for
ICF/IID services provided by a new ICF/IID in peer group 1 or peer group 2
shall be determined in the following manner:

(1)
The
initial rate for capital costs shall be determined under section 5124.17 of the
Revised Code using the greater of the new ICF/IID's actual inpatient days or an
imputed occupancy rate of eighty per cent.

(2)
The
initial rate for direct care costs shall be determined as follows:

(a)
If
there are no cost or resident assessment data for the new ICF/IID as necessary
to determine a rate under section 5124.19 of the Revised Code, the rate shall
be determined as follows:

(i)
Determine the median cost per case-mix unit under division (B) of section
5124.19 of the Revised Code for the new ICF/IID's peer group for the calendar
year immediately preceding the fiscal year in which the rate will be
paid;

(ii)
Multiply the amount determined under division (B)(2)(a)(i) of
this section by the median annual average case-mix score for the new ICF/IID's
peer group for that period;

(iii)
Adjust the product determined under division (B)(2)(a)(ii) of
this section by the rate of inflation estimated under division (D) of section
5124.19 of the Revised Code.

(b)
If the
new ICF/IID is a replacement ICF/IID and the ICF/IID or ICFs/IID that are being
replaced are in operation immediately before the new ICF/IID opens, the rate
shall be the same as the rate for the replaced ICF/IID or ICFs/IID,
proportionate to the number of ICF/IID beds in each replaced ICF/IID.

(c)
If the
new ICF/IID is a replacement ICF/IID and the ICF/IID or ICFs/IID that are being
replaced are not in operation immediately before the new ICF/IID opens, the
rate shall be determined under division (B)(2)(a) of
this section.

(3)
The
initial rate for indirect care costs shall be the maximum rate for the new
ICF/IID's peer group as determined for the fiscal year in accordance with
division (C) of section 5124.21 of the Revised Code.

(4)
The
initial rate for other protected costs shall be one hundred fifteen per cent of
the median rate for ICFs/IID determined for the fiscal year under section
5124.23 of the Revised Code.

(C)
The initial total medicaid day payment rate for
ICF/IID services provided by a new ICF/IID in peer group 3 shall be determined
in the following manner:

(1)
Except
as provided in division (D)(2) of this section, the department shall adjust a
new ICF/IID's initial total per medicaid day payment rate determined under this
section effective the first day of July, to reflect new rate determinations for
all ICFs/IID under this chapter.

(2)
If the
department accepts, under division (A) of section 5124.101 of the Revised Code,
a cost report filed by the provider of a new ICF/IID, the department shall
adjust the ICF/IID's initial total per medicaid day payment rate in accordance
with divisions (D) and (E) of that section rather than division
(D)(1)
of this section.